Lloyd Mulenga, M.B.Ch.B., Ph.D., on Zambia’s ‘basic minimum package’ | AIDS 2026

After U.S. funding uncertainty hit Zambia's HIV program in January 2025, officials at the country's Ministry of Health, along with other members of the government, scrambled to reviewed the country’s HIV to decide what could be scaled back without causing significant harm, according to Lloyd Mulenga, M.B.Ch.B., Ph.D., M.Med., M.Sc., director of infectious diseases at the Zambia Ministry of Health. The result is the “basic minimum package” of HIV services, Mulenga said in an interview with Managed Healthcare Executive (MHE) before the AIDS 2026, the 26th International AIDS Conference, being held in this week in Rio de Janeiro, Brazil.

Mulenga spoke about the basic minimum package and other adjustments to disruption in outside funding during the plenary session of the AIDS 2026 meeting this morning. Mulenga told that MHE that the basic minimum has since been adopted in some form by governments in Malawi, Mozambique and Kenya, and that his country has applied the same model to its tuberculosis and malaria programs.

“They bottom is that the minimum packages for countries are not a treat from ambition; it’s coming to reality,” Mulenga said in his plenary session talk. “It’s a strategic decision to deliver the right services to the right people and we need to define which of these services are needed in each country. We need to cost those services, we nee to need to own those services and we need also to fund those services.”

Rather than fund vehicles, fuel and allowances to send teams into communities for HIV testing, the basic minimum package concentrates resources on facility-based testing and on reaching the partners of pregnant women who came in for antenatal care or prevention services, he said dViral load testing in pregnancy, previously repeated every three months, was scaled back toward a single test, a trade-off Mulenga said the ministry made after determining the effect on outcomes would be limited. Voluntary medical male circumcision was folded into routine surgical services rather than run as a separate community outreach program. Some programs for adolescent girls, such as the DREAMS initiative, which focused on social and other factors that make them vulnerable to HIV infection, were harder calls because, said Mulenga, their costs are immediate but their benefits, such as preventing future HIV infections, only show up over time.

Mulenga said he shared the basic minimum package model with other countries through platforms including the International AIDS Society and Global Fund to Fight AIDS, Tuberculosis and Malaria meetings, and that it evolved iteratively as the World Health Organization and community groups weighed in. Countries that have adopted versions of it have adapted some elements to local conditions, he said, but follow the same underlying model.

Mulenga also touched on the same transition theme in his plenary session presentation, calling for domestic expenditure tracking, protection of core HIV services such as antiretroviral drugs and community health workers, and a phased path toward more than 50% domestic financing over roughly five years.